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THE CATARRHAL CHILD
Whether mucopus is obtained or not from the sinus the adenoids are
removed if they are present, and some authorities believe that removal of
adenoids alone without proof puncture will clear up any sinus infection by
improving the nasal airway and thus aerating the sinus.
Nose drops of 0-5 per cent ephedrine hydrochloride with silver protein
(Argotone) may be prescribed. They are best administered to a child by laying
him flat on his back on a bed with his head hanging over the side. If he
sniffs in as the two drops are instilled into each side the medication is thus
dispersed throughout the nasal cavities.
It is uncommon for children to require further sinus surgery as described in
Chapter 14. Some surgeons perform intranasal antrostomy on children for
chronic sinusitis, and some even advocate such an operation routinely when
the tonsils and adenoids are removed if there is radiographic opacity of the
sinuses. There seems to be little to commend this, and there are few criteria
for intranasal antrostomy in children. It should be borne in mind that
childhood is a period of upper respiratory tract infections; that most children
improve with simple conservative therapy including proper nose blowing and
nose breathing; that radiography may show sinus opacity which is due simply
to a lack of air entry into the sinuses; and that nasal allergic oedema is
frequently combined with a mild chronic rhinitis to cause persistent catarrh.
By the same token it is even more uncommon for radical sinus surgery to be
undertaken in childhood except in the case of complications of sinusitis which
do not resolve with antibiotics, or in the case of malignant diseases when
biopsy of the intrasinus tumour is necessary.
Conservatism should be the standard practice in the catarrhal child in
whom the aims of treatment should be the establishment of free drainage, the
training in proper nose blowing to evacuate the catarrh so drained into the
nasal cavities, and nasal breathing to allow the nasal mucus and the cilia to
fulfil their physiological functions.